Saturday, August 9, 2008

Further conversations with insurance

I spoke with a case manager from our Health Insurer. They say we qualify for case management (not sure if I want to) and are sending out the information. It is voluntary.

The case manager is a pediatric RN and she explained our out-of-state coverage in more details. Basically, we are covered the same as at home as long as the institution AND providers are contracted with their local Blue Cross/ Blue Shield networks.

Lucile Packard is contracted as an institution and Hanley is contracted as a surgeon so it sounds straightforward. Not quite. She advised that I check with the hospital that everyone on the ICU, Cardiology, Surgical and Anesthesia teams are contracted as individuals. Apparently, hospitals are able to contract medical personnel who contract independently. So, we could be billed by an out-of-network physician at a covered hospital.

According to Billing at LPCH they have an institutional physician contract (or some words to that effect) and we will not find individuals who are not with Blue Cross etc.


Erika said...

Do you read Andrea? ( I know she has experience with Dr. Hanley and Lucille Packard. I'm sure if you browse through the last 4 months or so of archives, you'll find his name over and over. Or you could just email her-

Andrea said...

These conversations sound so familiar! That's what I was told at LPCH too, that if their hospital was covered, all their doctors were covered too. I was warned to document everything, so just print everything you can find that says you are covered, and take detailed notes of phone conversations including names and dates. So far I think we're good on the bills, but we're still sorting some things out.